ACT Questions and Answers - October 19, 2016

November Association Visits

Noridian education representatives will be in attendance at the following association meetings:

  • November 7 - Pennsylvania Orthotic and Prosthetic Society (POPS) Association Harrisburg, PA
  • November 9-11 - New Jersey American Academy of Orthotists and Prosthetists (NJAAOP) Atlantic City, NJ

November Webinars Available

The Noridian Outreach and Education (POE) team offers the following educational event for all DMEPOS suppliers. Attendance at events is encouraged to obtain the most current information. To attend an upcoming event visit the POE Schedule of Events.

Event Date Time
DME Basics: Background Knowledge November 1 11 a.m. ET
DME Basics: General Documentation Requirements November 2 11 a.m.  ET
DME Basics: Claims and Appeals November 3 11 a.m. ET
PMD Prior Authorization November 8 1 p.m. ET
Respiratory Assist Devices & Vents November 9 11 a.m. ET
Immunosuppressive Drugs November 10 3 p.m. ET
Knee Orthoses November 30 3 p.m. ET
Therapeutic Shoes for Persons with Diabetes November 29 11 a.m. ET

Redetermination and Written Reopening Submission Available through NMP

Noridian encourages suppliers to use the Noridian Medicare Portal (NMP) to submit redeterminations to streamline office operations. Take advantage of this self-service tool to eliminate time-consuming faxing or hardcopy mailing. The portal is easy to use and allows suppliers to attach all supporting documentation electronically. Another plus is the real time confirmation number; no more calling the Interactive Voice Response (IVR) to confirm receipt!

Visit our Noridian Medicare Portal today to learn more. If a supplier's company has not yet enrolled in the Noridian Medicare Portal, please share this notice with the company official so the organization can learn about all the benefits of joining. The instructions for joining the Noridian Medicare portal are detailed on the Noridian Medicare website.

Appropriate Coding and Billing of Lower Limb Prosthetic Covers and Covering Systems

This article was originally published on July 18, 2013 and is being re-published for informational purposes. No content has changed.

Due to high volume submitted claims for the lower limb prosthetic (LLP) covers and protective covering systems, Noridian Healthcare Solutions republished this article. Suppliers who provide LLP covers and covering systems should review the article here.

Medtrade Week of October 31

Medtrade is coming back to the Georgia World Congress Center in Atlanta, GA on October 31 – November 3, 2016. Join Medicare Administrative Contractors - Common Electronic Data Interchange (CEDI), Competitive Bidding Implementation Contractor (CBIC), National Supplier Clearinghouse (NSC), and representatives from the four DME MAC jurisdictions at the exhibit hall at Booth #2361.

Exhibit Hall Hours:

  • November 1 - 2: 10:00 AM – 4:00 PM Eastern
  • November 3:  10:00 AM – 1:00 PM Eastern

DME MAC Comprehensive Error Rate Testing (CERT) Task Force Medtrade Educational Session - November 1

The DME MAC CERT Task Force will present an educational session at Medtrade in Atlanta, Georgia on November 1, 2016 at 2:45 pm ET in room C102. The session will review top DME category errors along with a questions and answers session. The DME MAC CERT Provider Outreach and Education Task Force is comprised of individuals from the four DME MACs whose focus is on lowering the CERT error rate through education.  The DME MAC CERT Provider Outreach and Education Task Force is separate from the CERT contractors and the CMS CERT team. Visit  for registration information, the complete show schedule, and list of exhibitors present on the tradeshow floor.

Monthly Q&A Sessions

Noridian DME education staff continue to offer online Question & Answer (Q&A) sessions the second Monday of every month for suppliers to ask general documentation and policy specific questions. Registration is required and available on the Schedule of events webpage.


Change Request (CR) 9741 provides guidance to the MACs for handling claims for replacement of essential accessories for beneficiary-owned Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) purchased by Medicare. When making a payment determination, MACs will review the necessity of replacing a CPAP or RAD accessory when the beneficiary-owned base CPAP or RAD continues to meet the medical need requirements.

Therefore, to make a payment determination MACs will only review:

  • The base DME item continued medical need requirements, including documentation from the physician or treating practitioner that indicates the CPAP or RAD that requires replacement accessories continues to be medically necessary. For this purpose, documentation is considered timely when it is on record in the preceding 12 months; and
  • The medical necessity of the replacement of specific accessories or furnishing of new accessories and whether they are essential for the effective use of the base DME.

Be aware that your MAC will ensure that the supplier's documentation records support the need to replace the accessory to maintain the equipment's functionality and meet the beneficiary's medical need. In the event that certain accessories are furnished for the first time, such as a heated humidifier or heated tubing, contractors will ensure that the accessories are medically necessary.

Self Service Options

Reminder: Self Service Options vs calling contact center for claim inquiries and beneficiary eligibility. Noridian is committed to providing superior customer service to our DMEPOS suppliers and want to ensure that our Contact Center Customer Service Representatives (CSRs) are available to assist those callers with complex inquiries which cannot be answered through the Interactive Voice Response (IVR). CSRs are unable to provide callers with information that is available within the IVR. Per CMS Internet Only Manual Publication 100-09, Chapter 6, Section 50.1, Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. Callers with inquiries that may be answered using the IVR will be guided back to the IVR

Electronic Supplier Visits Available for JA Suppliers

Noridian DME would like to offer the opportunity for suppliers to receive up to a 90 minute individualized education. This education is specific to your company and will be tailored to your specific educational needs. To request this one-on-one education, please complete the following form. These requests will be processed in the order they are received. An Education Representative will contact you as time allows. If JA Suppliers are only requesting answers for single questions, please call the JA Supplier Contact Center at 1-866-419-9458. This form is available on the forms tab of the Noridian Medicare website.

Assigned vs. Non-assigned claims Webinar

The DME MACs are tentatively planning a joint webinar on assigned, and non-assigned claims. The tentative date right now is December 14. Please ensure that you are registered for our Listserv to receive the announcements when registration is available.

Questions and Answers

Q1. Why aren't E-scripts that are transmitted directly from the prescriber considered a note from the doctor or prescriber saying that this is the appropriate documentation that is needed?
A1. This is a common thing that we hear of, but something to remember is a prescription is not part of the medical record. It is actually excluded, so continued use and continued need is required. A prescription by itself may not be sufficient. NHS would require continued need medical records to support the medical documentation is ongoing. From your first request was how come NHS didn't prepare you for the volume that you are receiving. We can't share that information and not only that we would never know because it is a random sampling of claims that are selected.

Q2. We have documentation that includes cholesterol, obesity, chronic coxiella, diabetes, but the treatment notes do not indicate a diabetic management visit, however, diabetes was addressed, such as poor circulation, peripheral neuropathy, but no mention the need for diabetic shoes. Does this qualify the patient for diabetic shoes?
A2. The therapeutic shoes medical policy is diagnosis driven. The medical records do have to support the documentation the coverage criteria in the LCD and the policy article. The treating physician's notes do not actually have to state that they need diabetic shoes. They do have to meet other criteria. It does have to support that diabetic condition and that qualifying condition, one of those listed in the policy, i.e. 2-A through 2-F. You were saying that you have notes that say peripheral neuropathy, and that alone does not meet for one of the qualifying conditions. The medical records would have to support that they have peripheral neuropathy with evidence of callous formation.

Q3. Treatment note for diabetic shoes is showing chief complaint was chronic heart failure, but in the details includes documentation about type 2 diabetes. Would this be considered a diabetic management visit because it said that the chief complaint was chronic heart failure?
A3. As long as it's a certifying physician that did that in-person visit and they are addressing the diabetic management that would be fine.

Q4. How are the dates for Home Health (HH) populated the portal for eligibility?
A4. The home health agency would have to correct their billing by re-submitting with the correct discharge date from the common working file.

Q5. For capped rental equipment, if we choose to provide a patient with oxygen or a PAP device and we submit the claim non-assigned, are we required to have the patient sign an authorization form every month?
A5. Yes, an authorization is required on a monthly basis for capped rentals when billing non-assigned. As per the claims processing manual, issued by CMS, indicates that in general you can have a one-time authorization, however, DME rental is the exception to that. You may reference the Internet Only Manual (IOM), 100-4, Chapter 1, §50.1.6 for additional information.

Q6. We received a denial on a detailed written order (DWO) that was stamp dated. The date was typed in on the order the day it was signed. Is it required that every valid DWO have a handwritten date?
A6. Date stamps are not acceptable for a signature date. As a reminder, the signature date must be in a consistent format as the signature. 

Q7. Can we send medical records older than 12 months?
A7. Yes, you may send the documentation that is older than 12 months as long as it's pertinent to the items in question. However, it is important to include timely documentation as stated in the Local Coverage Determinations (LCDs). (Timely documentation is defined as the preceding 12 months (from the date of service in question).

Q8. Is a revised DME Information Form (DIF) required when there is a change with the administration of a drug?
A8. Any change to the administered drugs would need a revised DIF submitted. Suppliers may have to contact their software vendor for instructions on how to attach the DIF in this situation.

Q9. Can we provide equipment within the same Healthcare Common Procedure Coding System (HCPCS) as an upgrade? An example, a rollator walker, a basic version of a walker and one that has additional items included, but within same HCPCS code?
A9. No. If it's within the same HCPCS code it would not be considered an upgrade.

Q10. What documentation is needed to support supplies for a PAP?
A10. Continued use can be documented by the supplier as well as the physician. Suppliers should document the continued use that the beneficiary benefits from these items or supplies you're providing the beneficiary and they are still reasonable and necessary. Continued need can only be documented by the treating physician within the medical record.


Last Updated Jun 07, 2019